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First-time National Council Licensure Examination for Registered Nurses (NCLEX) pass rate is an important indicator of nursing school success and quality. Programs employ different methods to anticipate NCLEX outcomes, help prevent student failure, and reduce the threat to program accreditation from poor NCLEX pass rates. This study explored the relationship between scores on high-stakes exams and NCLEX outcomes when no progression or graduation policies were tied to student outcomes. Other course components including use of an online adaptive system designed to help students practice and master course content were also explored to determine potential benefits as part of a comprehensive NCLEX preparation strategy.